FLORIDA · 2015-03-27 · Phentermine 37.5 mg #30 prescription six times: on or about October 10,...

I. .)

STATE OF FLORIDA DEPARTMENT OF HEALTH

BOARD: Nursing

CASE NUMBER: 2009-06112

COMPLAINT MADE BY: Jeffrey B. Sack, M.D. 3050 Bee Ridge Road, Suite B

Sarasota, Florida 34239

DATE OF COMPLAINT: March 27, 2009

SUBJECT: Cynthia Marie Coffin, R.N. 1089 Delacroix Circle Nokomis, Florida 34275

SUBJECT'S ATTORNEY: Jeffrey Haynes, Esquire 240 North Washington Boulevard Suite No. 460 Sarasota, Florida 34236

INVESTIGATED BY: James Williams Tampa

REVIEWED BY: Mary S. Miller Assistant General Counsel

RECOMMENDATION: 4097 Reconsideration

CLOSING ORDER ON RECONSIDERATION

THE : The Complaint alleged that Subject violated Section 464.018(1)0), Florida Statutes (2009), by being unable to practice nursing with reasonable skill and safety to patients by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any other type of material or as a result of any mental or physical condition.

THE : The Complaint alleges that on or about Odober 6 2008, the Subject submitted a prescription for phentermine 37.5 milligrams, to the Family Drugstore, Inc., ostensibly authorized by Dr. .Jeffery Sack, M.D. The Complaint alleges that on or about September 18, 2009, the Department ordered the Subject to submit to a mental and physical evaluation to determine her ability to practice nursing with reasonable skill and safety. The Complaint alleges the Subject submitted to the evaluation and the independent evaluator opined was then unable to practice nursing with reasonable skill and safety.

The Department filed an Administrative Complaint on or about March 18, 2010, alleging the Subject was unable to practice nursing with reasonable skill and safety. On or about April 14, 2010, the Subject, through her attorney, requested a formal hearing at the Division of Administrative Hearings.

Since the filing of the Administrative Complaint, the Subject submitted to a second mental and physical evaluation, at her own expense. On or about February 13, 2014, the Subject submitted a mental and physical evaluation with Dr. D.M., M.D, an IPN-approved evaluator. Dr. D.M. opined that the Subject did not meet any DSM-IV criteria for alcohol or substance abuse. Dr. D.M. also opined the Subject is. safe to practice nursing with reasonable skill and safety. As part of her evaluation with Dr. D.M., the Subject submitted to urine, hair, and PEth tests which all returned negative.

The Subject demonstrated she is currently safe to practice nursing with reasonable skill and safety. The Subject submitted to a second mental and physical evaluation with an IPN-approved evaluator on or about February 13, 2014. The second evaluator opined the Subject is currently safe to practice nursing with, reasonable skill and safety. As part of the February 13, 2014 evaluation, the Subject submitted to urine, hair, and PEth tests which all returned negative. Therefore, there is insufficient evidence to demonstrate the Subject is currently in violation of Section 464.018(1)0), Florida Statutes.

The Department's burden of proof at DOAH is clear and convincing evidence that a licensed practical nurse violated the nurse practice act. There was sufficient evidence for the Panel to have found probable cause.

DON v. Cynthia Coffin, RN. 2 Case Number: 2009-06112

However, based. on the above facts, the Department, pursuant to the provisions of Section 20.43(3), Florida Statutes, has determined that there is insufficient evidence to support the continued prosecution of the allegations .contained in the Administrative Complaint. Therefore, pursuant to Section Florida Statutes, this case is hereby DISMISSED.

It is, therefore, ORDERED that this mafter be, and same is hereby, DISMISSED. .

DONE AND ORDERED this

______

day of

_________________,

2015.

CHAIRPERSON, PROBABLE CAUSE PANEL BOARD OF NURSING

/MSM .

PCP:

PCP Members:

DOH v. Cynthia Coffin, R.r1. 3 Case Number: 2009-06112


DEPARTMENT OF HEALTH,

PetiUoner,

CYNTHIA MARIE COFFIN, tNa,

Respondent I

Case

ADMINISTRATIVE COMPLAINT

COMES NOW, Petitioner, Department of Health, by and through its

undersigned counsel, and files this Administrative Complaint before the

Board of Nursing against Respondent, Cynthia Marie Coffin, R.N., and in

support thereof alleges:

1. Petitioner is the state department charged with regulating the

of ñUShg ØUSÜâIitId Section 20.43, Florida Chapier

456, Florida Statutes; and Chapter 464, Florida Statutes

2. At all times material to this Complaint,, Respondent was a

registered nurse (R.N.) within the state of Florida, having been issued

license number RN 3347602.

3. Respondent's address of record is 1089 Delacroix Circle,

Nokomis, Florida 34275.

4. From on or about March 1, 2004, through on ot about February

20, 2009, Respondent was employed as a R;N. by Jeffrey B. Sack, M.D.,

(Dr. Sack), in his private medical practice.

5. On or about October 6, 2008, Respondent submitted a

prescription for Phentermine 37.5 mg #30 with six refills, to the Family

Drugstore, Inc., ostensibly authorized by Dr. Sack.

6. Phentermirie is a stimulant commonly prescribed to assist with

weight loss. According to Section 893.03(4), Florida Statutes, phentermine

is a Schedule IV controlled substance that has a low potential for abuse

relative to the substances in Schedule III and has a currently accepted

medical use in treatment in the United States, and abuse of phentermine

may lead to limited physical or psychOlogical dependence relative, to the

substances in Schedule IlL

7. On or about March 9, 2009, a box arrived at Dr. Sack's office

via U.S. Mail addressed to Respondent.

8. On or about March 9, 2009, Dr. Sack opened the box addressed

to Respondent and discovered a prescription medication bottle with

DON v. Cynthia Coffin, tN. 2

Case Number: 2009.06112 MiIIer\AC\j charge\Cofflnr RN post OCE.doc

Phentermine tablets for Respondent, with Dr. Sack listed as the prescribing

physician.

9. Dr. Sack contacted the pharmacy and obtained a copy of

Respondent's prescription for Phentermine, ostensibly authorized by Dr.

Sack, and purportedly bearing Dr. Sack's tEA number and signature.

10. The Family Drugstore, Inc., reportedly filled Respondent's

Phentermine 37.5 mg #30 prescription six times: on or about October 10,

2008; November 11, 2008, December 3, 2008, January 2, 2009, February

4, 2009, and March 6, 2009.

11. On or about September 18, 2009, the Department ordered

Respondent to submit to a mental and physical examination to determine

her ability to practice nursing with reasonable skill and safety pursuant to

the authority granted in Section 464.018(1)(J), Florida Statutes.

Octoher..i2, to the

compelled mental and physical examination which was conducted by a

specialist in addiction psychiatry.

13. The evaluator diagnosed Respondent with stimulant abuse

versus dependency.

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14. The evaluator opined that Respondent's behavior was

suspicious for having either an abuse or dependency problem.

15. The evaluator opined that Respondent is unable to practice

nursing with reasonable skW and safety.

16. The evaluator recommended that Respondent enter the

Intervention Project for Nurses (IPN) and follow all recommendations,

complete an intensive out-patient drug treatment program for further

evaluation and assessment, submit to frequent drug urine screens, abstain

from using alcohol and other mood altering substances while in the IPN,

and undergo psychological testing.

17. IPN is the impaired practitioner program for the Board of

Nursing, designated pursuant to Section 456.076, Florida Statutes. IPN is

the program that monitors the evaluation, care, and treatment of. impaired

nurses. IPN oversees random drug screens and provides for the exchange

of information eer the

Department for the protection of the public.

18. Registered nurses are required to assess the condition of their

patients and make complex decisions regarding patient care. Mental

DON v. Cynthia Coffin, R.N. 4 Case Number: 2009-06112 J:\PSU\Nursing\Mary MiIIer\AC\j charge\Coffin, RN Post OCE.doc

fitness and emotional stability are essential traits that a registered nurse

must possess in order to competently. practice nursing.

19. 464.018(1)0), Florida Statutes (2009), provides that

being unable to practice nursing with reasonable skill and safety to patients

by reason of illness or use of alcohol, drugs, narcotics, or chemicals or any

other type of material or as a result of any mental or physical condition

constitutes grounds for discipline of a Ucensee by the Board of Nursing.

20. As set forth above, Respondent is unable to practice nursing

with reasonable skill and safety to patients due to opiate abuse and/or

opiate dependency.

21. Based on the foregoing, Respondent violated Section

464.018(1)(j), Florida Statutes (2009), by being unable to practice nursing

with reasonable skill and safety to patients by reason of illness or use of

alcohol, drugs, narcotics, or chemicals or any other type of material or as a

resuitof any mental Or physical thhditibn.

WHEREFORE, the Petitioner respectfully requests that the Board of

Nursing enter an order imposing one or more of the following penalties:

permanent revocation or suspension of Respondent's license, restriction of

practice, imposition of an administrative fine, issuance of a reprimand,

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placement of the Respondent on probation, corrective action, refund of

fees billed or collected, remedial education and/or any other relief that the

Board deems appropriate.

SIGNED this day of 2010.

Ma NI. Viamonte Ros, M.PJ-I. State Surgeon General

FILED Mary S. MHIeP nEPARTMENT OF HEALTH

pEPUTY CLERK Asststant General Counsel

2 ° 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar Number 0780420 (850) 245 - 4640 Telephone (850) 245.— 4683 Facsimile

.PCP: PCP Members:

.

DOH v. Cynthia Coffin, P.M. 6 Case Number: 2009-06112 J:\PSU\Nursing\Mary MUIer\AC\j charge\Coffin, RN post OCE.doc

NOTICE OF RIGHTS

Respondent has the right to request a hearing to be conducted Dnaccordar.ce with Section 120.569 and 120.57, Florida Statutes, - be represented by cotrns& or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena tecum issued on his or her behalf if a hearing is requested,

NOTICE REGARDING ASSESSMENT OF COSTS

Respondent is placed on notice that Petitioner, has incurred costs related to the investigation and prosecution of this , Pursuant to Section '456.072(4), Florida Statutes, the Board shall assess costs related to the 'Investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other disciphne imposed.

DOH v. Cynthia Coffin, R.N. ' 7

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• Order No. D0W084130- -MQA _________ Department of Heai

STATE OF FLORIDA BOARD OF

DEPARTMENT OF EEALTH,

Petitioner,

vs. DOH CASE NO.: 2006-36715 LICENSE NO. 56807

JEFFREY B. SACK, M.D.,

Respondent.

/ FINAL ORDER

THIS CAUSE came before the BOARD OF MEDICINE (Board)

pursuant to Sections 120.569 and 120.57(4), Florida Statutes, on

April 4, 2008, in West Paint Beach, Florida, for the purpose of

considering a Settlement Agreement (attached hereto as Exhibit

A) entered into between the parties in this cause. Upon

consideration of the Settlement Agreement, the documents

submitted in support thereof, the arguments of the parties, and

being otherwise full advised in the premises, the Board rejected

the Settlement Agreement and offered a Counter Settlement

Agreement which was accepted on the record by the parties. The

Counter Settlement Agreement incorporates the original

Settlement Agreement with the following amendments:

1. The letter of concern set forth in Paragraph 1 of the

Stipulated Disposition shall be deleted.

,

2. The costs set fdrth in paragraph 3 of the Stipulated

Disposition shall be set at $3,518.32.

3. The continuing medical education (CME) set forth in

paragraph 6 of the Stipulated Disposition shall be deleted.

4. Respondent shall document the completion of 5 hours of

continuing medical education (CME) in the area of ethics within

one (1) year from the date this Final Order is filed. These

hours shall be in addition to those hours required for biennial

renewal of licensure. Respondent shall first submit a written

request to the Probation Committee for approval prior to

performance of said CME course(s). Unless otherwise approved by

the Board or the Chairperson of the Probation Committee, said

continuing education courses shall consist of a formal live

lecture format.

5. Respondent shall be and hereby is REPRIMANDED by the

Board.

IT IS HEREBY ORDERED AND ADJUDGED that the Settlement

Agreement as submitted be and is hereby approved and adopted in

toto and incorporated by reference with the amendments set forth

above. Accordingly, the parties shall adhere to and abide by

all the terms and conditions of the Settlement Agreement as

amended.

This Final Order shall take effect upon being filed with

the Clerk of the Department of Health.

DONE AND ORDERED this /6 day of

2008.

arty herson, ., Executive Director For Fred Bearison, M.D., Vice-Chair

CERTIFICATE OF SERVICE

I HEREBY CERTIFY that a true and correct copy of the

foregoing Final Order has been provided by U.S. Mail to Jeffrey

B. Sack, M.D., Poet Office Box 15157, Sarasota, Florida 34277;

to Allen R. Grossman, Esquire, Metzger, Grossman, Furlow & Bayo,

LLC, 1408 N. Piedmont Way, Tallahassee, Florida 32308; and by

interoffice delivery to Ephraim Livingston, Department of

Health, 4052 Bald Cypress Way, Bin 4tC-65, Tallahassee, Florida

32399-3253 this

_______

day of l 2008.

fleputy Agency Clerk

S. STATE OF FLORIDA

DEPARTMENT OF HEALTH

DEPARTMENT OF HEALTH, 1 v. CASE NO. 2006-36715

C,

JEFFREY B. SACK, M.D,.

RESPONDENT,

___________I

ADMINISTRATIVE COMPLAINT


undersigned counsel, and files this Administrative Complaint before the

Board of Medicine against the Respondent, Jeffrey B. Sack, M.D., and in

support thereof alleges:

1. Petitioner is the state department charged with regulating the

practice of medicine pursuant to Section 20.43, Florida Statutes; Chapter

456, Florida Statutes; and Chapter 458, Florida Statutes.

2. At all times material to this Complaint, Respondent was a

licensed physician within the State of Florida, having been issued license

number ME 56807.

S 3. The Respondent's address of record is P.O. Box 15157,

Sarasota, FL 34277.

4. At ail times material to this complaint, the ResØondent was

issued Drug Enforcement Administration ("DEA") registration number

B52674883, which entitled him to purchase, prescribe, and dispense

controlled substances in Schedules II, Ill, IV, and'!.

5. At all times material to this complaint, the Respondent's DEA

registration number did not authorize the Respondent to purchase,

prescribe, or dispense any controlled substance exclusively used for the

treatment of opiate drug addiction, including Suboxone and Subutex.

Suboxone and Subutex are narcotics used to treat narcotic dependence by

preventing withdrawal symptoms.

6. At all times material to this complaint, the Respondent was not

a registered participant in the DEA-regulated Office-Based Opiold

Treatment ("OBOT") program, which is a requirement for the handling of

Suboxone and Subutex.

7. bn or about April 25, 2005, the Respondent received from•

Besse Medical three (3) bathes of Suboxone with each containing thirty

(30) tablets and three (3) bottles of Subutex with each containing thirty

(30) tablets.

70 .3671S\(r) & ) crime & self-piescrlblng acAoc

16165

S 14. On or about February 21, the Respondent received from

Besse Medical six (6) bottles of Suboxane with each containing thirty (30)

tablets.

jS. On or Bbout July 11, 2006, the Respondent received from

Besse Medical six (6) bottles of Suboxone with each containing thirty (30)

tablets and three (3) bathes of Subutex with each containing thIrty (30)

tablets.

16. On or about October 4, 2006, the Respondent received from

Besse Medical six (6) bathes of Suboxone with each containing thirty (30)

tablets and two (2) bottles of Subutex with each containing thirty (30)

tablets.

17. On or about October 4, 2006, a consensual search of the 's residence at 7615 lng Road, Sarasota, Florida. 34242,

by law enforcement revealed an itional quantity of fifteen and one half

(15 ½) tablets of Suboxone present at that location.

18. The Respondent admitted to law enforcement that he obtained

the above-alleged quantities of Suboxone and Subutex for personal

consumption.

19. On or about October 19, 2006, the Respondent was arrested

on several felony charges. On or about February 5, 2007, the Respondent

Casey\cnes'$tztuF 70 as&sarJc OS-3blISVr) & (c) & seff.prasctibing ac.dx 4

16167

S was charged by informatiQn with ten (10) felony counts of Obtaining

Controlled Substance by Fraud and one (1) felony count of Possession of

Controlled Substance.

On or about July 31, 2007, the Respondent was charged by

amended information, which replaced the original information, with one (1)

third-degree felony count of Scheme to Defraud (Less Than The

amended information alleged that in Sarasota County, Florida, between

April 25, 2005, and October 2, 2006, the Respondent did unlawfully

engage in a scheme constituting a systematic, ongoing course of conduct

with intent to defraud one or more persons or with intent to obtain

property from one or more persons by false or fraudulent pretenses,

representations, or promises or willful misrepresentations of a future act,

and so obtained property from of an aggregate value of less than $20,000,

contrary to Section 817.034(4)(a)3., florida Statutes, in such case made,

and provided against the peace and dignity of the State of florida.

21. On or about July 31, 2007, the Respondent entered a nob

contendere ("no contest") plea to one (1) third-degree felony count of

Scheme to Defraud and was placed on five (5) years probation under the

supervision bf the Florida Department of Corrections. The Respondent's

special conditions of probation included undergoing a drug evaluation and

Casey\Cases\Status 70 CZSeS\SaCK 06'3671S\(r) & C) ate & ac.doc

16168 —

16169

S referral within forty-five (45) days of the plea, performing fifty (SO) hours

of community service work, and undergoing a DNA test with a provision for

the application of early termination of probation after half is completed.

22. The crime of Scheme to. Defraud relates to the practice of

medicine or to the ability to practice medicine since it involved a scheme to

fraudulently obtain controlled substances for the Respondent's own

personal consumption. Furthermore, the qualities essential to the practice

of include reliability, honesty, and good moral character. The

crime for which the Respondent pled no contest demonstrates that the

Respondent lacks these essential qualities. By demonstrating that the

• Respondent lacks these essential qualities, the Respondent's crime relates

to his ability to practice medicine by showing that he is not worthy to be

entrusted with the privileges and authority vested In those who are

licensed to practice medicine.

COUNT ONE

23. Petitioner realleges and incorporates paragraphs one (1)

through twenty-two (22) as if fully set forth herein.

24. Section ,331(1)(r), Florida Statutes (2004-2006), provides

that prescribing, dispensing, or administering any medicinal drug appearing

on any schedule set forth in Chapter 893 by the physician to himself or

):\PSI'W4eaIcaI'jiatthew c 7QcazeMsaCk & C) CcVne & se4f (1

S * herself, except one prescribed, dispensed, or administered to the physidan

by another practitioner authorized to prescribe, dispense, or administer

medicinal drugs constitutes grounds for discipinary action by the Board of

Medidne.

25. The Respondent prescribed,, dispensed, or administered

Suboxone andfor Subutex, which appears on Schedule II in Chapter 893,

to himself on or about one or more of the following dates: April25, 2005,

June 2, 2005, August 10, 2005, August 11, 2005, October 21, 2005,

November 11, 2005, January 3, 2006, February 21, 2006, July 11, 2006,

and/or October 4, 2006.

26. Based on the foregoing, the Respondent has violated Section

458.331(1)(r), ida Statutes (2004-2006), by prescribing, dispensing, or

administering any medicinal drug appearing on any schedule set forth in

Chapter 893 by the physician to himself.

COUNT TWO

27. Petitioner realleges and incorporates

through twenty-two (22) as if fully set forth herein.

28. Section , Florida Statutes (2006), provides that

being convicted or found guilty of, or entering a plea of nob contendere

to, regardless of adjudication, a crime any jurisdiction which directly

Casey\cases\SlatUS 70 0&36715\(1 & C) thm€ & -DteWtibIflg ac.doc

paragraphs one (1)

relates to the practice of medicine or to the ability to practice medicine

constitutes grounds for disciplinary action by the Board of Medicine.

29. On or about July 31, 2007, the Respondent entered a nob

contendere ("no contest") plea to one (1) third-degree felony count of

Scheme to Defraud and was placed on five (5) years probation under the

supeniision of the Florida Department of 1 The crime of

Scheme to Defraud relates to the practice of medicine or to the ability to

practice medicine since it involved a scheme to fraüdulêntly obtain

controlled substances for the Respondent's own personal consumption.

Furthermore, the qualities essential to the practice of medkfine include

reliability, honesty, and good moral character. The crime for which the

Respondent pled no contest demonstrates that the Respondent lacks these

essential qualities. By demonstrating that the Respondent lacks these

essential qualities, the Respondent% crime relates to his ability to practice

medicine by showing that he is not worthy to be entrusted with the

privileges and authority vested in those who are licensed to practice

medicine.

30. Based on the foregoing, the Respondent has violated Section

458.331(1)(c), Florida Statutes (2006), by being convicted or found guilty

of, or entering a plea of nob contendere to, regardless of adjudication, a

casey\Cases\Status 10 caseAsack O6aEfl!\(r) & (c) crime & seW•prtsalbing ac.doc

0 S

16171

$

S , crime in any jurisdiction which directly relates to the practice of medicine

or to the ability to practice medicine.

WHEREFORE, the Petitioner respectfully requests that the Board of

Medicine enter an order imposing one or more of the following penalties:


practice, imposition of an administrative fine, Issuance of a reprimand,


fees billed or couected, remedial education and/or any other relief that the


SIGNED this JO day of 2007.

ia M. Viamonte Ros, M.D., M.P.H State Surgeon General

•

,:t irj IT

fl4T:

Matthew Casey Assistant General Counsel DOll Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, FL 32399-3265 Florida Bar # 0115320 (850) 245-4640 ext. 8173— phone (850) 245-4681 — fax

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PCP: December 7, 2007 PCP Members: Leon, dine & Beebe

Case4Cas&i$tabs 70 06-367t5\(r) & ) me & setfpresating ac.doc 9

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S DOll v. Jeffrey B. Sack, M.D., Case #2006-367 15

NOTICE OF RIGHTS

Respondent has the right to request a hearing to conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her beh&f it a hearing is requested.


Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to. the investigation and prosecution of a

disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed.

):\PSJV.ledic2IV'latthew Casey\CaseflStatus 70 czses\Sack & crime & se!!-presatng ac.doc

02/27/2088 13: t& :3355 .1 SC< O 82

STATE OF FLO*IDA DEPAMMENT OF HEALTh

onMm EN? OF HEALTh,

PetIUoner,

v. DOM Case No.

s s*cx, II.D.,

IENT Jeffrey SacIç P&D.,. referred to as the ¶€SPGMent," and the Department of

Health, referred to and agree to the Agreement

and to the entry of a Final of the Board of Medicine, referS to as

tntorporat(ng the Stipulated Facts and Stipulated Disposition In this matter.

Petitioner Is the stath agency. charged with regulating the practice of

medicine pursutit to Section Rprtda Statutes, and Chapter 456, FIrnida

Statutes, and 458, Flotide

STIPULAThD FAPTh

lb At all times material hereto, Respondent was a licensed physician in

the State of Florida having been issued licente number Hf 56807.

2. The Depaitment charged Respondent with an Administrative

Complaint that was filed and properly served upon Respondent with iolations of

Midcic.b V,a Dab4and '

62/27/2009 13:16 9419263359 3 SACK MD 93

Chapter 458, Florida Statutes, and the rules adopted pursuant

the Mmiriistratlve int is attached A.

3. neither admits nor denies the fact cntalned.

ri the Mministratlve complaint ses of these pmceed%t&gs ly.

SDPUI4TED CONCLUSIONS OF LAW

1. Raspondent.adtnlts , in hIS capacity as a IlcensS physician, he is-

to the provisions of 456 aVid 458, FlorIda Statutes.,. and the

of the Department and the Board.

2. Respondent admits that the facts alleged Ive Complaint, if proven, would constitute violations of Chapter 458, Pbrlda Statutes,

as allegçd in the Admtnlsfrattve Complaint.

3. agrees that the Stipulated in this is -mit,

appropriate and

IPULATED DISPOSITION

I. Letter oV:crntcaru - Respondent shall iteive -a Letter of Concern

from the Board of

2. - The Board of shall impose administrative fine of

TEN THOUSAND DOLLARS ($10,000.00) against the license of Respondent, to be

paid by Respondent to the Department of Health, HMQAP4S/Client Services, Post

Office Box 6320, Tallahassee, Florida 32314-6320, Attention: Board of

Compliance Officer, within thirty-days (30) from the date of Thing of the Final Order

accepting this Agreement. All fines shall be paid by chec or money ordbn The

2

Va$a.S

16175

@2/27/2e80 13:i6 i PAGE S4

Board office does not have the authority to change the terms of payment of any

fine imposed by the Board.

RESPONDENT ACKNOWLEDGES TNAT THE TIMELY OP TIlE

£5 HIS LEGAL OBLISAUON A$D RESPONSIBILITY AND

RESPONDD4T AG9EES TO tEASE IF FINE IS NOT PThID

AS &GREED TO 1k ThIS SET(LEMtN AGRESaT,. SflcIflçALLY; It WITHIN 4ä DAYS OP DATE PILING OF THE FINAl. ORDER,.

RESPONDENT tIAS NOt RECEIVED WtUUNCONflRMATION THAT tHE

ruit AMOUNT 'OP ThE FinE Nfl. BEEN RECEiVED BY THE BOARD OPHCE,

RESPONDENT AGREES TO. CEASE PRACTICE UNTIL SUCH WRrrTEN

CONPIRMAfl0N IS RECEIVED SY REspQwbthT FROM SOflL 3. Pthtuant to Sedjoii 456.0Th, Flbrida

StaMes, Respondent agree to pay the Departnient for any administrative aists

incurred In the investigaton and prnsecutJon of this case. Such costs exdude the

costs ct obtaining supavision or monitotlng of the prattice, the coSt of quality

assurance and the Boat administrative cost directly with

Responderft's probation, if any. The agreed upon amount of Department cna to

be paid in this case tnCJLJdeS but shall not exceed FOUR ThOUSAND TWO

HUNDRED DOLLARS($4,�ofl.0o). Respondent will pay costs w the Department of

Health, KMQAMS/Cflent Services, P:O. Ccx 6320, Tallahassee, FlotIda 323 14-632Q,

Attetêon; floard of Medicine Compliance within (30) from the

3

Mscbiofl hit ThAsSacsd Sse3c 06467

16176

02/21/2309 13:16 3 SACk MD -

date of filing of the l Order In is cause. Any post-Board costs, such as the

costs associated with probation, are not Included in this agreement.

RESPONDENT ACK%OWLW1ES ThAT THE TUIELY OF THE

COSTS IS HIS LEGAL MID RESPONSIBILItY AND

RESPONDENt AGREES TO CEASE PRACITCING ir COStS ARE NOT

PALO AS AGREED TO IN THIS SETI1XMWT IF

WITHIN DAYS OF THE DATE OF FIUN6 OF ThE PINAL ORDER,

RESPONL)ST HAS NT *ECEIVED WRrTEN coflzRMkfldN. ThAT THE

FULL AMOUNT OF TN! COSTS VIOUD ABOVE HAS BY TUE

BOARD OFFICE, RESPONDENT AGREES TO CEASE PRACflCE UNUL SUCH

WRITTEN CONflRV4A1IO# IS PICUVED BY RESPONMNT FROM THE

BOARD.

. LawS And Rules Course . shall the Laws and

Rules Course, adrhinisteyed by the florida Medical within one (1) year

of the date of filing of the Final Order of the Board. In Respondent

subrn1t dàcuméntation in the Mn of certified copies of the vouchers,

certificates, or other papers, such as physidarl's recognition awards, documenting

completion Of this medical education course within one (1) year of The date of filing

of the l Order Intorpotating this Agreement. *0 sudi ntation l be seq W the Board of Medidre. reaaSlestot whed*risonte or anvaf

suth doatmeidation was durlnn the wprse of

audit or discussion with counsel for the . These hours shall be

4

16177

- 62/2712P08 13:16 5419262359 .3 SACi< MD a7

within one (1) year of the date of filktg of tha Final Order in this matter. l! such

documentation shall be sent to the Board of Medicine? regardless of whether some

or any of such documentation was provided previously during the course of any

audit or wkh counsel i the These hours shaH be In

addftjon to those hours required fbr renewal of licensure.

. . 4$sutanca

- An independent, certified hsk manager will review Respondent's .ctflnt practice

within six months of the date of of the Final Order. Speclfitálty, Ut independent o,Sultat shell review the offle procSures employed at

Respondents practice. This consultant will prepare a repott addressing

Respondent's practice. This report will Include suggeSd of the

quality assurance of Respondent's pnctlce. will submit This

weB as documentation that demonstStes Smpllance with the suggestions

enuinaittS in repbt ki the Pitbetion Committee. Respondeit shall bear the

cost of suth wns&jlMon and aqy necessary or appropriate snsultabon.

8. PRN. Cnah'act — The Respondett must In

Comp4lance with l terms of his PRN

STANDARD IONS 1. Respondent is required to appear before the Board at

the meetIng of the Board where this•Agreement Is considered.

6

fljkK U*a sa06.3G71

16179

19:16 941926fl59 3 SAU( hID PAct oe

2. iorce or mfcct untiLfinal at - It is expressly understood

that this Agreement Is subject to the approval of the Board and the Department.

in this regard, the foregoing paragraphs (and only tha foregoing paragraphs) shall

have no force and effect unless the Board enters a Anal Order kwporating the

terms of this P.grttneit

-3. Mdresses - Respondent must keep cuflent Idence and ptaaice

addresses on file with thi Board. nt shall notify the Board I bin ten

• (10) days of any changes of sal&addtesses. .

4, PatuM.C*rnduct -In the future, ResppndentshaO not vIolate Chapter

456, 458 or 893, lorIda Statutes, or the rules promulgated pursuant thereto, or

any other sthte or federal law, Me, or regulation -to M or the

to practice medidnie. Prior to. difl i seed

ChaptSt 456, 458 and and the Rat of of Madidrte, S hapter 6408,

Flodda Admhiistradve Code.

5. Violation, of terms aM4ldeted - it is tcpressly that a

violation of the terms of this Agreement shall be considered a VIOlaboti or a Final

Order of the Board, for which disciplinary action may be initiated, pursuant to

4% aAd 458, ida Statutes.

6. Purvose of AureSnent ror the purpose of avoiding

further admlnl*atlve action with respect to this cause, executes Ut Agreement.

in this regard, Respondent authorizes the Board to review and examine all

igative file materials concerning Respondent prior to or in conjunction with

7

TTh%3s flue, DneSawd $S

0

02/27/28a8 13:16 9419263359 .3 SACK MD B9

consideration of the Agreement. aspondert agrees to support this Agreement at

the time it is presented S the Board and shall offer no testimony or

argument that disputes or contravenes any stipulated fact or conclusion of law.

Furthermore, should this Agreement not be accepted by thi Board, It is agreed

that prsserttatlon th and consideration of ttjls Agreemeflt•and.other dotuments and

matters by the Beard shall not unfebly or ilIeq&W pr any of Its

members fttm further particpedon, or resolulion of these

proteedlnçs.

7. of - Respondent and the

• Department ftifly understand that this. Agreement and subsequent Final Order

incorposthg same will In no way preclude additional by the Scar4

and/or Ut Department inst Responde* for atts or omissions not

set forth in the Mmlnlstrative Complaint attached as Exhibit A.

8. Waiver of aftatneVs fleas and icostS - Upon the Board's adoption

of this Agreement the parties hereby agree that with the excepth n of noted

abOve, the parties will bear their own attorneV's fees and costs resulting from

prosecution or de(ertse of this matter. Respondent waives the right th seek any

attorney's fees or costs from the Department and the Board In connection with this

matter.

• 9. Waiver at furthetppgcedural steps - Upon the Board's adoption of

this Respondent expressly waives all further procedural steps ard

expressly waives all rights to seek judidal review of or to otherwise challenge Or

S

Mat,wh Vie Ssdc 06.3 flVlSEDZOC

16182

jüv/2èei1a:1& 1419253359 .3 SAO( D

contest the validity of the Agreement and the Final Order ol the Board g, said Agteeiiie)'it.

F3Rai&4.4Y . I H

JEFffiEY a. SACK,

STATE OF FLC3IDA COUNTY OF j$1

Before personally appeared Jeffrey B. Sadç wtwse identity is known to

me Cr by l!Cenct (type 'afld who, under

oath, acknowledges that his signature appears above.

Sworn to and subscilbed before rfl? this Q7 day.: 08.

My Commission

APPROVED this 32±dav of_____________________________ 2008.

Ma P4. Viamonte Ros, M.D., State ' Matthew S. Casey 0

Assistant General Counsel Department of Health

MSCJcI3S

9


BOARD: Nursing

CASE NUMBER: 2014-11653

COMPLAINT MADE BY: S.P, R.N., Director of Nursing I the Willough at Naples

COMPLAINT MADE AGAINST: Charlene Paul, L.P.N. 2200 Greenback Circle, Apt. 102 Naples, Florida 34112

SUBJECT'S ATTORNEY: Thomas Dickens III, Esq. Dickens Reid 516 East College Avenue Tallahassee, Florida 32301

DATE OF COMPLAINT: July 22, 2014

INVESTIGATED BY: ISU- Fort Myers

REVIEWED BY: Lindsay Wells Grogan, Esq.

RECOMMENDATION: Dismiss (4099)

CLOSING ORDER

THE : The complaint alleges that the Subject violated Section 464.018(1)(j), Florida Statutes (2013-2014), being unable to practice nursing with reasonable skill and safety to patients by reason of marijuana abuse.

THE : On or about November 5, 2014, S.P., M.D., conducted a Department-ordered evaluation of the Subject. Dr. S.P. diagnosed the Subject with marijuana abuse. Dr. S.P. opined that the Subject cannot practice as a LPN with reasonable skill and safety and recommended that she enter an Intervention Project for Nurses (IPN) extended diagnostic contract.

DICKENS REID Parinern ii Low

February 23. 2015

Via E•auill Mi Lindsay Cirogan Florida Orparlruroill oi Haaitlr Proarcrutiori Services lJvIl .1052 held Cypress Way Tullstrsoaee. FL 32300

Re. Na

float Me (hogan

was good speaking milk your agent todoy about Ike above case. I woo iropIatj that you cordd gal Dr Perunasly ) clarity Iris araloaliun iii Ms Paut—upectficaly lie utatoaroel in yaragrapur 5, page 5 wtrarsriru ho aphws lluai Ms Paul in a is practice raising. -. I rrssld aol fool Ii aypnrprteie to toRe away her license I burl liar utile to practice at trio ttrrra -

rut a seperols psrlroa or liar snulaatttrrr, Dr. Parmaaty racraiiuaartds toil tirartose Patti airier an ealsirutad dtagrirwlic contract with C Aoioittaitty, I bass oat seen aim a! those castracts ardors. but vsvnrtirviaha would aotr l,is Paul to salt Into 11151 type at prograurr through IPN Ta be sure, my paotiiea rare to that (lie tiaclar baa dslsrreteahl tier sods to prier-lice given tip diaeussiav oe IrallO 5

kayo spolras wllh ,i!,!•I I

nI!!I hic, rliucs lvi tori ill 555 iIsirKi liii second acaaitootrsll hurl' Ii Parnreaty's opiviaa I would ask Ihat yotr wyrtest clarihicatisa 10w Di tonvu hr and with yarir taller at raytiosl, ptsaoa tarviard tarn a

copy at thin coriaupw'danca iuudtcaiing lay cllnol'a pasitigur. I wcrsrtit also nate that cry client twa tastructad ate to cliatbiaqe the baeailrsaaCs pasitiarl containing tins ssrarwt Order Ia Compel Esawtaatiaa in circuit carat ptaeesat Ia PS 12013 It we cannel resolve thorn

I appreciate your peick raapaaao nail I trirrrw thai we can put the Is 'ant taurly

rtiiickly

I Dictions. lit -

'A pc

A ¶5 ikj i

15:57 Wit lard Hurtey law 850 224 2030 >> I.'

ELECTION OF ITS 1)011 v. Charlene Paul, LY.N. Case No. 201 4-11 653

Please sign and complete all of the information below:

I received notice of the Administrative Complaint on the following date: 2 fi N /

PLEASE SELECT ONLY 1 OF TIlE 2 OPTIONS

An Explanation of Rights is attached. Wyou do not understand these options, please consult with your attorney or

ct,ntact the attorney for the Prosecution Services Unit at the address/phone number listed at the bottom of this form.

OPTION 1.

_________

I do not dispute the allegations of material fact in the Administrative Complaint. I do wish to

be afforded a hearing, pursuant to Section 1 20.57(2), Florida Statutes, at which time I will be permitted to submit oral

and/or written evidence in iiiitigatioii of' the complaint to the Board.

OP'l'lON 2. A 1 do dispute the allegations of material fact contained in the Administrative Complaint and

i'cqnest this to be cousidej'ed a petition lot formal hearing, l to Sections 120,569(2Xa) and 120.57(1 Florida

Statutes. before an Adniiiiistrativc 1 .aw indge appointed by tlic Division uf Admiiiistrative 1-tearings. Pursuant to

Uisifoi'in Rule 28106.2015(5), Florida Administrative Code, I wcifk'ally dispute the following material facts

(identified by paragraph number and fact disputed) in the Administrative Complaint:

7 'p ,z U — . S .

__________________

. . -

- -.. - '.

-______ Respondent's Signature Attorney/Qualified Representative*

Address: - Address: .

Lie. No.: ,______ PhoneNo.:

Phone FaxNo.:_____ FaxNo.: , " -.

,mail:__ Email: / C

STATE OF IDA *Qualified Representatives must file written

COUNTY OF __. - requests to appear as such pursuant to

Rule 28-106.106, Uniform Rules of Procedure.

Before mc, personally appeared

______

... whose identity is known to me, or who produced

(type of identification) as identification, and who acknowledges that his/her signature appears above.

Sworn 10 or affirmed before me this day of __, — -. - 20

Notaiy Public-State of Florida My Commission Expires

'ype or Print N ante

PI.EA.SE MAIL AND/OR FAX COMPLETED FORM TO: Lindsay Wells Grogan, Assistant General Counsel. DOH, Prosecution Services

Unit, 4052 Bald Cypress Way, Bin C-65, Tallahassee, Florida 32399-3265. Telephone Number: (850) 245-4444 ext. 8161; FAX (85,0) 245-

4662; Till) -955-8771

9/11/2014

Mission: To protect promote & improve the health

of all people in Florida through integrated

state county & community efforts.

Rick Soott Govemor

John H. Armstrong, MD, FACS State Surgeon Geoerat & Secretary

FLORIDA DEPARTMENT OF HEALTH

Petitioner

Vision: To be the Healthiest State in the Nation

vs Case No,201416653

CHARLENE PAUL, LPN

Respondent

COMES NOW, the affiant, who first being duly sworn, deposes and states:

1) Affiant is an Investigator/Inspector employed by the DEPARTMENT OF HEALTH, State of Florida.

2) That on January 28, 2015, Affiant made a diligent effort to locate Respondent, to serve X_ Administrative Complaint

and related papers; Order compelling examination(s); Subpoena(s);

_________Final

order;

___________Notice

to cease and desist; ESO/ERO and related papers.

3) Check applicable answer below:

X Affiant made personal service on Respondent, or on some person at Respondent's usual place of abode over

the age of 15 residing there, on January 28, 2015 at 2060 Estey Avenue, Naples, FL 34104.

________Aft

iant was unable to make service after searching for Respondent at: (a) all addresses for Respondent shown

in the DOH investigation of the case; (b) all official addresses for Respondent shown in his licensing records on the

computer terminal or Board office; (c) Local telephone company for the last area Respondent was known to frequent;

(d) Division of Drivers

Licenses; and (e) Utilities (electric, cable, etc.); any others:

A

Affiant

State Of Florida

County Of Lee

Before me, personally appeared Marie Haves

CAROLINE BURT

I

A Commission # a 865287 Expires March 19,2017

Itwu tray 8003,e•mrn

INV FORM 321, Revised /14 J3

AFFIDAVIT OF SERVICE OR DILIGENT SEARCH

petsonallv

appears above.

_________________________________whose

identity is known to me by -

(type of identification) and who, acknowledges that his/her signature

Sworq ;o or affirmed by Affiant before me this 29 day of > c/tCW-Oj I /j

Notary Public-State of Florida My Commission Expires

— — 7 /

C

Type or Print Name

STATE OF FLORIDA

DEPARTMENT OF HEALTH

INVESTIGATIVE REPORT

Office: VIII — Ft. Myers Date of Case: 7/22/14 Case Number: 201411653

Subject: CHARLENE PAUL, LPN 2200 Greenback Circle, Apt. 102 Naples, FL 34112* 754-423-0840 (c)

Source: STACEY PALAIA, RN/DON The Willough at Naples 9001 Tamiami Trail E Naples, FL 34113 239-775-4500

Related Case(s): NONE Date and Type of Report: /29/15 SUPPLEMENTAL 4

Alleged Violation: FS 456.072(k)(z)(aa)(dd) and ,018(1)(j)(o)

Synopsis: This supplemental is predicated upon the receipt of a request from PSU ALYSON MOTES for LINDSAY WELLS GROGAN, Esq. for service of an Administrative Complaint, (AC) to CHARLENE PAUL, LPN.

EXHIBITS:

EXHIBIT S4-1 is the request from PSU page 2

EXHIBIT S4-2 is the affidavit of service page 3

INVESTIGATOR NOTE:

Investigator MARIE HAYES served the AC to DERRICK CHAPELL, significant other of CHARLENE PAUL on 1/28/15 at 2060 Estey Avenue, Naples FL 34104.

Received InvestigatIve Services

FEB 032315

Investigator/Date: /_29.../L5 7. 6 Caroline Burt

J) , Medical Quality Assurance Investigator, FI-77 love igationd Manager, FI-73

Distribution: HQ/ISU Page 1

INV FORM 300, Revised 3/14, 2/08, CreaLed 07/02

IDOH/MQp,

HQ

*PAUL gave her address in Supplemental I as 2060 Estey Avenue, Naples, FL 34104.

C), ;o

r

: I

Mission: To protect, promote & improve the health

ol all people in Florida through integrated

slate, county & community efforts


PSU REQUEST FORM

FROM: K Carraway for Lindsay Wells Grogan, TO: ISU Judy Nichols Esq.

Date: 1/21/2015 1

TO: CSU

Phone #: 850-245-4444 ext 8167 j CC: CaroUne Burt

Number: 2014-11653 — Subject: Charlene Paul

Requested Completion Date: ASAP

(PSU) TYPE OF REQUEST: (describe details below)

Z Process Service* (Activity Code 160)

fl Additional Information Requested (Activity Code 145)

fl Deficiency in Investigative Work (Activity Code 150)

Details: Please hand serve,

*The following additional information is needed for each service request:

Last Known Address Last Known Name & Phone Number: Last Known Place of Employment & Address if Known: Has Contact Been Made With This IndMdual? YES fl N0EIJ; If Yes, ? Was this case originally worked byCSU or in an area office different from where this service request is being sent? YES No I NOTE: All process service requests need to be sent to appropriate field office. **1F YES, please send a copy of the original InvestIgative Report without . QSU/CSU) RESPONSE:

Process Service Completed (Activity Code 161) fl Process Service NOT Completed (Activity Code 162)

LI Additional Info Sent to Legal (Activity Code 156)

fl Supp. Investigation Request Cancelled (Activity Code 157)

Email to: Pensacol Tallahass

ee —

Alach ua —

Jacksonvi lIe —

St. — Pete

Tamp a -

Orland o -

Ft West Palm

Ft Lauderdale

Miam .

r Services ULA

INY FORM 376, Created 4/05 .

'Rick Scott Governor

John H. Armstrong, MD, FACS State Suigeon General & Secretary

Board: EAU HL Code: HLLII8a Status: 67

Carraway, Katherine

From: Carraway, Katherine

Sent: Wednesday January 21, 2015 1:02 PM

To: DL MQA mv Serv Priority Mail Area8 (Fl) Ft.Myers

Subject: Supplemental

Supplemental Charlene Paul

1.21.15 ,docx returned AC.pdf

Katie Carraway, Regulatory Specialist I

Assistant to Lindsay Wells Grogan

Office of the General Counsel

Prosecution Services Unit

Florida Department of Health

4052 Bald Cypress Way, Bin #C-65

Tallahassee) FL 32399-3265

(850) 245-4444, ext. 8200

Please note: Florida has a very broad public records , Most written communications to or from state officials

regarding state business are public records available to the public and media upon request. Your e-mail communications

may therefore be subject to public disclosure.

1-low m I communica bug? ContafLrrv super . However, if this e-mail concerns anticipated or current litigation or adversarial administrative proceeding to which the

Florida Department of Health is a party, this email is an attorney-client communication, and is, therefore, a limited

access public document exempt from the provisions of Chapter 119, Florida Statutes.

See Section 119.071(d)1., Florida Statutes (2010).

To protect, promote & improve the health of all people in Florida through Integrated state, county, & community

efforts. New vision statement: Healthiest State in the Nation

New Values: (ICARE)

I nnovation: We search for creative solutions and manage resources wisely.

C ollaboration: We use teamwork to achieve common goals & solve problems.

A ccountability: We perform with integrity & respect.

R esponsiveness: We achieve our mission by serving our customers & engaging our partners.

E xcellence: We promote quality outcomes through learning & continuous performance improvement

There have been changes to the license renewal process. Please visit www.CEAtRenewal.com to learn more.

Rick Scott Mission: Governor

To protect promote & improve the health

John H. Armstrong, , FACS State Sur9eon General & Secretary

Vision: To be the Healthiest State in Die Don

PSU REQUEST FORM

FROM: K. Carraway for Lindsay Wells Grogan, TO: ISU Judy Nichols

Esq.

1/21/2015 TO:CSU

LPhone_#: 850-245-4444 ext 8167 CC: Caroline Bud

Case Number: 2014-11653 Board: EAU Subject: Charlene Paul HL Code: HLL1I8a Status: 67

Requested Date: ASAP

(PSU) TYPE OF REQUEST: (describe details below)

Z Process Service* (Activity Code 160)

El Additional Information Requested (Activity Code 145)

El Deficiency in Investigative Work (Activity Code 150)

Details: Please hand serve.

,e following additional information is needed for each service request:

Last Known Address Last Known Name & Phone Number:

Last Known Place of Employment & Address if Known: Has Contact Been Made With This Individual? YES El l; If Yes, ? Was this case odginally worked by CSU or in an area office different from where this service request is being sent?

YES El NOTE: All process service requests need to be sent to appropriate field office. *IF YES, please send a copy of the Investigative çport without . -

(ISU/CSU) RESPONSE: El Process Service Completed (Activity Code 161) El Process Service NOT Completed (Activity Code 162)

El Additional Info Sent to Legal (Activity Code 156)

El Supp. Investigation Request Cancelled (Activity Code 157)

Email to: Tallahass Alach Jacksonvi St. Tarn.p Orland Ft. Miarn Pensacol

ee ua He Pete a o Myers Palm Lauderdale

Consume r

Services ULA

NV FORM 376, Created 4/05

- CE

RT

IFIE

D M

AIL

C

C

CD

LiJ

_1

a

Florida D

epartment of H

ealth O

ftic of the G

eneral Counsel

ProE

ecution Services U

nit 4052.B

aId Cypress W

ay, Bin C

-65 T

allahassee, Florida 32399-1701 7196

9008 9111

1388 2639

- -

-- -

- - -

- -

-

-

2263 !i32

FL 3411?

0 c%J

—

Rick Scott Mission: Governor

To protect, promote & improve he health olalt people in Florida through integrated John H. Armstrong, MD, FACS state, county & community eltorts.

Ti State Surgeon General & Secretary 'I


December 17, 2014

Charlene Paul, L.P.N. 2200 Greenback Circle, Apt 102 Naples, FL 34112

Certified Number 71%

RE: Department of Health vs. Charlene Paul, . Case No. 2014-11653

Enclosed please find a copy of an Administrative Complaint that has been filed against your license by the Department of Health. An Election of Rights form and an Explanation of Rights form are also provided.

Please review the attached documents and return the Election of Rights form to my attention. You must sign the Election of Rights form, with your signature notarized, and return the completed form to my office within twenty-one (21) days of the date you received it. Failure to return this form within twenty-one days may result in the entry of a

default judgment against you without hearing your side of the . Sincerely,

Lindsay Wells Grogan Assistant General Counsel (850) 245-4444 Ext. 8167

www.FiorldasHealth.com TWITTER:HeatthyFLA

FACE :FLDepartmentofHeatth VOUTUBE: fldoh

Florida Department of Health Office of the General Counsel • Prosecution SeMcos Unit 4052 Bald Cypress Way, Bin C-65 ' Tallahassee, FL 32399-3562 Express mail address: 2585 Merchants Row — Suite 105

PHONE: 850/245-4444 FAX 850/245-4662

Dear Ms. Paul:

Enclosures

3. Respondent's address of record is 2200 Greenback Circle,

Apartment 102, Naples, Florida 34112.

4. At all times material to the Order, Respondent was employed at

The Willough at Naples (WN) located at 9001 Tamiami Trail East, Naples,

Florida 34113.

5. On or about November 5, 2014, S.P., M.D., conducted a

Department-ordered evaluation of Respondent.

6. Dr. S.P. diagnosed Respondent with marijuana abuse.

7. Marijuana contains cannabis. According to Section 893.03(1),

Florida Statutes (2013-2014), cannabis is a Schedule I controlled substance

that has a high potential for abuse and has no currently accepted medical

use in treatment in Florida and in its use under medical supervision does

not meet accepted safety standards.

8. Dr. S.P. opined that Respondent cannot practice as a LPN with

reasonable skill and safety and recommended that she enter an

Intervention Project for Nurses (IPN) extended diagnostic contract.

9. IPN is the impaired practitioner program for the Board of Nursing,

pursuant to Section 456,076, Florida Statutes (2014), IPN monitors the

evaluation, care and treatment of impaired nurses. IPN oversees random

DOH V. Chailene Paul, L.P,N. 2 DOH Case Numbe:

drug screens and provides for the exchange of information between

treatment providers, evaluators and the Department for the protection of

the public.

10. As of the date of this Complaint, Respondent has not contacted

IPN.

Section 464.018(l)(j), Florida Statutes (2013-2014), subjects a

practical nurse to discipline for b]eing unable to practice nursing with

reasonable skill and safety to patients by reason of illness or use of alcohol,

drugs, narcotics or chemicals or any other type of material or as a result of

any mental or physical condition."

12. Respondent is unable practice nursing with reasonable skill and

safety to patients due to marijuana abuse.


464.018(1)(j), Florida Statutes (2013-2014), by being unable to practice

nursing with reasonable skill and safety to patients by reason of illness or

use of alcohol, drugs, narcotics or chemicals or any other type of material

or as a result of any mental or physical condition.

WHEREFORE, Petitioner respectfully requests that the Board of

Nursing enter an order imposing one or more of the following penalties:

DOH v. Charlene Paul, LRN, 3 DOll Case Number 2014-11653


practice, imposition of an administrative fine, Issuance of a reprimand,

placement of Respondent on probation, corrective action, refund of fees

billed or collected, remedial education and/or any other relief that the


SIGNED this day of. , 2014.

John H. Armstrong, MD, FACS

State Surgeon General and Secretary of Health

FILED DEPARTMENT OF

DEPUTY

CLERK sanders DEC 1 7 2014

- Lindsay Wells Gragan Assistant General Counsel DOH Prosecution Services Unit 4052 Bald Cypress Way, Bin C-65 Tallahassee, Florida 32399-3265 Florida Bar Number 0088564 (850) 245 — 4444 x8167 Telephone (850) 245 — 4662 Facsimile

PCP Date: December 16, 2014 PCP Members: Sandra Walker Nichols, Jody Bryant Newman (Quorum)

DOH V. Charlene LP,N, 4 DOH Case Number 20 iA-i 1653

NOTICE OF RIGHTS

Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested.


Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this 1 Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition any other discipline imposed.

DOH v. Charlene Paul, L,P.N, 5 DOFI Case Number 11653

ELECTION OF RIGHTS

I)OH v. Charlene Paul, L.P.N. Case No. 2014-11653

Please sign and complete all of the information below:

I received notice of the Adminisirative Cotnplaiiit on the following date:

____________________________________

PLEASE SELECT ONLY 1 OF TUE 2 OPTIONS

An Explanation of Rights is attached. If you do not understand these options, Please consult with your attorney 01'

contact the attorney for the Prosecution Services Unit at the address/phone number listed at the bottom of this form,

OPTiON I .

_____________

I do not dispute the allegations of material fact in the Administrative Complaint, I do wish to be afforded a hearing, pursuant to Section 120.57(2), Florida Statutes, at which time I will be permitted to submit oral and/or written evidence in ni itigalion of the complaint to the Board.

OPTION 2.

_______________

I dispute the allegations of material fact contained in the Administrative Complaint arid request this to be considered a petition for formal hearing, lant to Sections 120.569(2)(a) and 120.57(1), Florida Statutes, before an Administrative Law Judge appointed by the Division of Administrative Ilearings. Pursuant to Uniform Rule 28-106.2015(5), Florida Administrative Cotle, I specifically dispute the following material facts (identified by paragraph number and fact disputed) in the Administrative Complaint:

Respondent's Signature Attorney/Qualified Address: Address:

________________________________

Lie. No.: - PhoneNo,:

Phone No.:

_________________Fax

No.:

________

Fax No.: -

mail: — Email: —

STATE OF FLORIDA *Qualified Representatives •iiust file written COUNTY OF requests to appear as such pursuant to

Rule 28-106.106, Uniform Rules of Procedure.

Before ne, personally appealed

_________,

whose identity is known to me, or who produced

(type of identification) as identification, and who acknowledges that his/her signature appears above.

Sworn to or affimied before inc this — - day of 20 .

Notary Public-State of Florida My Commission Expires

'lype 01 Print Name

PLEASE MAIL AND/OR FAX COMPLETED FORM TO: Lindsay Wells Grogan, Assistant General Counsel, DOlt, Prosecution Services Unit, 4052 Bald Cypress Way, Bin Tallahassee, Florida 32399-3265. Telephone Number: (850) 245-4444 ext. 8167; FAX (850) 245- 4662; TDD 1-800-955-8771

9/Il /2t) I 4


EXPLANATION OF RIGHTS

In the event that you fail to make an election in this matter within twenty-

one (21) days from receipt of the Administrative Complaint, your failure to do so

may be considered a waiver of your right to elect a hearing in this matter,

pursuant to Rule 28-106.111(4), Florida Administrative Code ("F.A.C."), and the

Board may proceed to hear your case.

In response to the allegations set forth in the Administrative Complaint issued by

the Department of Health, hereinafter referred to as the Department you should make

ONE of the following elections within twenty-one (21) days from the date of receipt of

the Administrative Complaint Please make your election on the attached Election of

Rights form and return it completed and signed before a notary to the address listed on

the form.

OPTION 1: If you do not dispute any material fact alleged in the

Administrative Complaint, you should select Option 1.

Once the Department receives your Election of Rights that does dispute any

material facts in the Administrative Complaint, you will receive a letter acknowledging

your election and informing you of the options available to resolve your case.

OPTION 2: If you dispute any material fact alleged in the Administrative

Complaint, you may request a formal hearing and the

appointment of an Administrative Law Judge to be furnished

by the Division of Administrative Hearings, pursuant to

Section 120.569(2)(a), Florida Statutes, by selecting Option 2

on the Election of Rights form.

You must indicate which facts you dispute in the Administrative Complaint

pursuant to Rule 28-106.2015(5), F.A.C.

If you elect a formal hearing, you must keep the Department informed as to your

current mailing address. Failure to do so may be considered a waiver of your right to a

formal hearing.

8/1/20 14

DICKENS I I

IIEE 11.1 tiL'u lt I

Partners Lit !AiW 1': ikifli 1,2' el 1

u kt.ict i

January 28, 2015

Via E-mail arid Facsimile: 850-245-4662 Ms. Lindsay Grogan Florida Department of Health Prosecution Services unit 4052 Bald Cypress Way Tallahassee, FL 32309

Re: DOH v. Paul; Case No. 1653

Dear Ms. Grogan:

I have been retained by Charlene Paul, L.P.N. in the above referenced matter

and to that end, I am submitting the attached confidentiality agreement executed on her

behalf. Also, I'm looking forward to sitting down next week to discuss the case with you.

In the meantime, if you have any questions or concerns, please don't hesitate to call

me.

Re specti ii ly

Thomas L. Dickens, Ill

Acknowlodçjninont of a ml Agreement to Maintain Patient Coiitidonlinlily

am the Subject ot on iiivestiçlation by Pie in tmecil ol I

As the Subject of such an investigation, I ani enlilleci In inspect or receive a copy ol the lv'?stkulIv

report, iucluclincj any expci I witness report or patent ecoids (tohllincted v,'h I'.

to Section (10). Floiicta Statutes, if I in wriling to niairhtcun he conlideniinhy

information receiver? undes this piuvisnin until 10 days aftrii rnab;ibto cause *s n Itie conhidentiality of patient records pui'suimt to Section 456.057, Florida Statutes

understand the cost associated with duplicating x—rays and I want ( ) do tot want ( ) 1;

recoive a COPY of any x-rays that are contained within the investigative file.

SIGNED this day )

(,lntricIn: I it ' is

14-1 1653

or

StONED this clay of _2L:::: j 2OiS, ) henall of Chartene I 'aui. t. 'il

Ihomas Dickens, Esq Counsel of Record 20 '1-11653

flick Scott Mission; Governoi

To protect! promote & reprove the health

of all people in Florida through integrated John H. Ariustronu, D, FACS state, county & community efforts. I

Stale Surgeon General & oecreialy L Ii. •. ! !

Vision; To be the Healthiest State in the Nation

January 28, 2015

Dickens Reid, PLLC Thomas Dickens, Esq. 517 E. College Avenue Tallahassee, FL 32301

Re: DOH v. Charlene Paul. L.P.N., Case No. 2014-11653

Dear Mr. Dickens

Pursuant to section 456.073(10), Florida Statutes, you requested a copy of the Department's

investigative file prior to the submission of this matter to the probable cause panel. Section

456.073(1 0), Florida Statutes, provides in part:

The complaint and all information obtained pursuant to the investigatton by the

department are confidential and exempt from s. 119.07(1) until 10 days after probable cause has been found to exist by the probable cause panel or by the department. or

until the regulated professional or subject of the investigation waives his or her privilege

of confidentiality, whichever occurs first. Upon completion of the investigation and a

recommendation by the department to find probable cause, and pursuant to a written request by the subject or the subject's attorney, the department shall provide the subject

an opportunity to inspect the investigative file or, at the subject's expense, forward to the subject a copy of the investigative file. Notwithstanding s. 456.057, the subject may

inspect or receive a copy of any expert witness report or patient record connected with

the investigation if the subject agrees in writing to maintain the confidentiality of any

information received under this subsection until 10 days after probable cause is found and to maintain the confidentiality of patient records pursuant to s. 456 057

Attached for your review is an Acknowledgement of and Agreement to Maintain Patient Confidentiality. Please sign and return the enclosed form to my office as soon as possible. The signed confidentiality agreement will be placed in our file.

Upon receipt of this form, and a determination by the Department to recommend that an Administrative Complaint be filed, a copy of the investigative file, including any expert witness report or patient record,

will be forwarded to you for review. Our office will not make dLtplicates of any x-rays contained within

the investigative file unless specifically requested to do so. You will have twenty (20) days

date of mailinn to file your response with the Department, unless an extension is granted by the

attorney handling this matter.

Florida Department of Health www.FloridasHoalth.com Oltice ol the General counsel

. TWITTFRHrltf.Fl '1052 Bald cypress Way, Bin C-65 Tallahassee, FL 32399-3265 IOOK FLDnparrivuiiothr:.ifl Express mail address; 2585 Merchants Row-S Suite 105 , . .,.

PHONE: 850/245/4444, ext 8144 FAX; 850/245/4862

Charlene Paul, L.P.N. Page 2

However, please note that the Department is only required to provide a copy of the investigative file

after the investigation has been completed and only if the Department is recommending an

Administrative Complaint. A copy of the file will not be provided if the Department recommends closure

of the complaint.

If you have any questions, please call me at (850) 245-4444, extension 8167.

Sincerely,

k 4Lifl1 Lindsay Wells Grogan Assistant General Counsel

LWG/kc

Enclosure: Confidentiality Agreement

Acknowledgement of and Agreement to Maintain Patient Confidentiality

I,

_____

am the Subject of an investigation by the Department of Health.

As the Subject of such an investigation, I am entitled to inspect or receive a copy of the investigative

report, including any expert witness report or patient records connected with the investigation pursuant

to Section 456.073(10), Florida Statutes, if I agree in writing to maintain the confidentiality of ly information received under this provision, until 10 days after probable cause s found and to !!i1rJ;

the confidentiality of patient records pursuant to Section 456.057. Florida Statutes.

I understand the cost associated with duplicating x-rays and I want ( ) do not want ( ) to

receive a copy of any x-rays that are contained within the investigative file.

SIGNED this day of 201_.

Charlene Paul, L.P.N 2014-11653

or

SIGNED this day of

____________________.

201_, on behalf of Charlene Paul, L.P.N

Thomas Dickens, Esq Counsel of Record 2014-11653


DEPARTMENT OF HEALTH,

Petitioner,

Case Nos. 2012-15645 V.

TIFFANY CRESSITA WILLIS, L.P.N.,

Respondent.

_____________________________________I

AMENDED ADMINISTRATIVE COMPLAINT


undersigned counsel, and files this Amended Administrative Complaint

before the Board of Nursing against Respondent, Tiffany Cressita Willis,

L.P.N., and in support thereof alleges:

1. Petitioner is the state agency charged with regulating the

practice of nursing pursuant to Section 20.43, Florida Statutes; Chapter


2. At all times material to this Amended Complaint, Respondent

was a licensed practical nurse (L.P.N.) within the state of Florida, having

been issued license number PN 5177791.

3. Respondent's address of record is 3206 Clark Drive, Sarasota,

Florida 34234.

4. At all times material to this Amended Complaint, Respondent

was employed as a licensed practical nurse (L.P.N.) at Crossbreeze Care

Center (Crossbreeze), a skilled nursing facility in Sarasota, Florida.

5. At all times material to this Amended Complaint, Resident J.L.

was a 63 year-old resident of Crossbreeze.

6. At all time material to this Amended Complaint, Resident J.L.

had a savings account with Bank of America.

7. On or about May 22, 2012, Bank of America issued Resident

J.L. an ATM card for his Bank of America savings account.

8. On or about May 22, 2012, Respondent helped Resident J.L.

activate his ATM card his Bank of America savings account.

9. From on or about May 22, 2012 until on or about October 3,

2012, Respondent retained possession of Resident J.L.'s Bank of America

ATM card for Resident J.L.'s savings account.

10. From on or about June 5, 2012 until on or about August 27,

2012, Respondent used Resident J.L.'s Bank of America ATM card and

DOH v. Tiffany Willis, L.P.N. 2 Case Numbers: 2012-15645

withdrew approximately $2,979.20 from Resident J.L.'s Bank of America

savings account, for her personal use.


2012, Resident J.L. did not authorize Respondent to use his Bank of

America ATM card to withdraw money from his Bank of America savings

account.

12. On or about December 11, 2012, in the Circuit Court for the

Twelfth Judicial Circuit, in and for Sarasota County, Florida, in case no.

2012-CF-016635-NC, Respondent was charged with one count of Grand

Theft, a third degree felony, in violation of Section 812.014(2)(c)1, Florida

Statutes, and one count of Fraudulent Use of a Credit Card, a third degree

felony, in violation of Section 817.61, Florida Statutes.

13. On or about November 4, 2013, in the Circuit Court for the

Twelfth Judicial Circuit, in and for Sarasota County, Florida, in case no.

2012-CF-016635-NC, Respondent entered a plea of nob contendere to one

count of Larceny — Theft of More Than $300.00, Less Than $5,000.00, a

third degree felony, in violation of Section 812.014(2)(c)1, Florida Statutes.


14. Respondent failed to report her plea of nob contendere to the

Board or the Department, in writing, within 30 days of the date of entering

the plea.

COUNT ONE


through fourteen (14) as if fully set forth herein.

16. Section 456.072(1)(x), Florida Statutes (2013), provides that

failure to report to the board, or department, in writing within 30 days after

the licensee has been convicted or found guilty of, or entered a plea of

nob contendere to, regardless of adjudication, a crime in any jurisdiction,

constitutes grounds for disciplinary action by the Board of Nursing.

17. Respondent failed to report her plea of nob contendere to one

count of Larceny — Theft of More Than $300.00, Less Than $5,000.00 to

the Board or the Department, in writing, within 30 days of the date she

entered the plea.


456.072(1)(x), Florida Statutes (2013), by failing to report to the board, or

department, in writing within 30 days after the licensee had been convicted


or found guilty of, or entered a plea of nob contendere to, regardless of

adjudication, a crime in any jurisdiction.

COUNT TWO


through fourteen (14), as if fully set forth herein.

20. Section 464.018(1)(e), Florida Statutes (2013), provides that

being found guilty of, regardless of adjudication, or entering a plea of nob

contendere or guilty to, any offense prohibited under Section 435.04,

Florida Statutes (2013), constitutes grounds for disciplinary action.

21. Section 435.04(2)(cc), Florida Statutes (2013), lists violations of

Chapter 812, Florida Statutes (2013), relating to theft, robbery, and related

crimes, if the offense was a felony.

22. As described above, on or about November 4, 2013, in the

Circuit Court for the Twelfth Judicial Circuit, in and for Sarasota County,

Florida, Respondent entered a plea of nob contendere to one count of

Larceny — Theft of More Than $300.00, Less Than $5,000.00, a third

degree felony, in violation of Section 812.014(2)(c)1, Florida Statutes.

23. Based on the foregoing, Respondent Section 464.018(1)(e),

Florida Statutes (2013), by violating Section 435.04(2)(z), Florida Statutes


(2013), by entering a plea of nob contendere to an offense prohibited by

Chapter 812, Florida Statutes, relating to theft, robbery, and related

crimes.

COUNT THREE


through fourteen (14), as if fully set forth herein.

25. Section 464.018(1)(h), Florida Statutes (2011)(2012), provides

that unprofessional conduct, as defined by board rule, constitutes grounds

for discipline.

26. Rule 64B9-8.005(4), Florida Administrative Code, provides that

unprofessional conduct includes stealing from a patient.

27. As set forth above, Respondent engaged in unprofessional

conduct by stealing approximately $2,979.20 from Resident J.L.'s Bank of

America savings account.


464.018(1)(h), Florida Statutes (2011)(2012), by engaging in

unprofessional conduct, as defined by Rule 64B9-8.005(4), Florida

Administrative Code, by stealing from a patient.


NOTICE OF RIGHTS

Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualified representative, to present evidence and argument, to call and cross-examine witnesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested.


Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall assess costs related to the investigation and prosecution of a disciplinary matter, which may include attorney hours and costs, on the Respondent in addition to any other discipline imposed.



DEPARTMENt OF HEALTH,

Petitioner,

Case No. 2012-15645 V.

TIFFANY CRESSITA WILLIS, L.P.N.,

Respondent.

/ ADMINISTRATIVE


underslgned counsel, and files this Administrative. Complaint before the

Board of Nursing against Respondent, Tiffany Cressita Willis, LP.N., and in

thereof alleges:

1. Petitioner is the, state department charged with regulating the

practice of nursing pursuant to Section 20.43, Florida Statutes; Chapter


2. At all times material to this Complaint, Respondent was a

licensed practical nurse (L.P.N.) within the state of Florida, having been

issued license number PN 5177791.

3. Respondent's address of record is 3206 Clark Drive, Sarasota,

Florida 34234. .

4.. At all times material to this Complaint, Respondent was

employed as a licensed practical nurse (L.P.N.) at Crossbreeze Care Center

(Crossbreeze), a skilled nursing facility in Sarasota,, Florida.

5. At all times material to this Complaint, Resident IL. was a 63

year-old resident of Crossbreeze.

6. At all time material to this Complaint, Resident IL,. had a

savings account with Bank of Americac . .

7. On or about May 22, 2012, Bank of America issued Resideht

J.L. an ATM card for his Bank of America savings account

8. On.or about May 22,2012, Respondent assisted Resident

activate his ATM card for savings account. .

9 From on or about May 22, 2012 until on or about October 3,

2012, Respondent retained possession of Resident J.L.'s Bank of America

ATM card for Resident J.L.'s savings account.

10. On or about June 5, 2012, Respondent used Resident J.L.'s

Bank of America ATM card and withdrew approximately $1,479.00 from

Resident J.L.'s Bank of America savings account. . .

DOE] v. Tiffany 2 Case 2012-15645 . .

MIIIeAAC\unprofconduct\LPN\WIIiis, LPN stealing from patientdàc

11. On or about June 5, 2012, Respondent did not give Resident

J.L. the $1,479.00 Respondent withdrew from Resident J.L.'s Bank of


• 12. On or about June 5, 2012; Respondent did not give Resident

IL. a receipt for the Respondent withdrew from Resident /s Bank of America savings accOunt.

• 13! On or about July 12, 2012, Respondent used Patient J.L.'s Bank

of America ATM card, and withdrew approximately $41.95 at Citgo Quick

Stop from Resident 1L.'s Bank of America savings account.

14 On or about July 12, 2012, Respondent did not give Resident

J.L. the $41.95 Respondent withdrew from Resident J.L:'s Bank of America

savings account.

15. On or about July 12, 2012, Respondent did not give Resident

.L. a receipt• for the $41.95 Respondent withdrew from Resident iL/s

Bank of America savings account.

• 16. Onor about July 19, 2012, Respondent used Resident J.L.'s

Bank of America ATM card and withdrew approximately $300.00 at a Bank

of America ATM from Resident J.L.'s Bank of America savings account.

olly. Willis, LP.N. 3 Case Number: 2012-15645 J:\PSU\NursingVlary MiiIerV \unpro(conduct\LPN\Willis, LPN stealing from patlent.dcc


J.L. the $102.00 Respondent Withdrew from Resident J.L.'s Bank of



J.L. a receipt for the $102.00 Respondent withdrew from Resident J.L.'s


25. On or about July 25, 2012, Respondent used Resident J.L.'s

Bank of America ATM card and withdrew approximately $100.00 at a Bank

of America ATM from Resident J L 's Bank of America savings account

26 On or about July 25,. 2012, Respondent did at give Resident .

IL.. the $100.00 Respondent. withdrew from. Resident Bank of

America savings account. .


•

3.L. a receipt for the $100.00 Respondent withdrew from Resident J.L.'s

Bank of America savings account. .

28. On or about July 26, 2012, Respondent used Resident J.L.'s

Bank of America ATM card and. withdrew approximately $122.SQ at a

Newtown Mini Mart ATM from Resident J.L's Bank of America savings

account. . .

• DOK V. Tiffany Wflhis, L,P.N. - . .

. 5 Case Number: 2012-15645 - 3:\SUQ4ursing\Mary Miila%C\unpror conduct\LPN\WiIlls, LPN stealing frOm


3.1.. the $122.50 Respondent withdrew from Resident 3.L.'s Bank of



IL. a receipt for the $122.50 Respondent withdrew from Resident L.'s


31. On or about July 30, 2012, Respondent used Resident J.L/s

Bank of America ATM card and withdrew approximately $81.95 at a Citgo

Quick Stop ATM from Resident 3 L 's Bank of America savings account —

32. On or aboUt July 30, 2012, Respondent did not give Resident

J.L. the $81.95 RSpondent withdrew from Resident ,L/s Bank of America

savings account. .

33. On orabout July30, 2012, Respondent did not give Resident

IL. a receipt for the $81.95 Respondent withdrew from Resident /s Bank of America savings account

34. Qn or about AUgust 6; 2012, Respondent used Resident J.L.'s

Bank of America ATM card and withdrew approximately $161.95 at a Citgo

Quick Stop ATM from Resident J.L.'s Bank of America savings account:

DOll v. Tiffany Willis, L.P.N. 6 Case Number: 2012-15645 -

J :\PSU\Nurslng\Mary MIIIeMC\unprof conduct\LPN\WliIis, LPN from paUent.doc -

35. On or about August 6, 2012, Respondent did not give Resident

IL. the $161.95 RSpondeht withdrew from Resident /s Bank of

America savings account. /

36. On dr about August 6, 2012, Respondent did not give Resident

J.L. a receipt for the $161.95 Respondent withdrew from Resident


37. On or about August 6, 2012, Respondent used Resident .J.L.'s

Bank of America card and withdrew approximately $42.00 at Expfeb

Grocery from Resident 3 L 's Bank of America savings account

38. On or.about August. 6, 2012, Respondent did not give Resident

3.L. the $42M0 Respondent withdrew from Resident 1L.'s Bank of America

savings account. . .

39. On or. about August 6, 2012, Respondent did not. give Resident

IL. a receipt for the $42.00 Respondent withdrew from Resident J.L.'s

Bank of America savings account. . . .

40. On or about August 7, 2012, Respondent used Resident 3.L.'s

Bank of America ATM card and withdrew approximately $82.00 at Expreb

Grocery from Resident 3.L.'s Bank of America savings account.

DON V. tifany Willis, 1PM 7 2012-15645 - .

MlIIer\AC\unprof ccnduct\LPN\WllIis, LPN stealing from patiaitdoc

• 41. On or about August 7, 2012, Respondent did not give Resident

1L. the $82.00 Respondent withdrew from Resident J.L.'s Bank of

savings account.

42. On or about August 7,2012, Respondent did not give Resident

).L. a receipt for the $82.00 Respondent withdrew from Resident J,L.'s


43. On or about August 17, 2012, Respondent used Resident .J.L.'s

Bank of America ATM card and withdrew $81.95 at a Citgo

Quick Stop ATM from Resident J.L.'s Bank4 America savings account..

44. On or about August 17, 2012, Respondent did not gJve

Resident 3.L. the $81.95 Respondent withdrew from Resident /s Bank of

• America savings account.

45. On or about. August 17, 2012, Respondent did not give

Resident IL. a receipt for the $81.95 Respondent withdrew from Resident

J.L/s Bank of America savings account.

46. On or about August 23, 2012, Respondent used Resident /s • Bank of America ATM card and withdrew approximately $81.95 at a Citgo

Quick ATM from Resident J.L.'s Bank of Americi savings account.

I

DOH V. Willis, LP.N. • S

Case Numb&: 2012-15645 - • MlUer\AC\unprof conduct\LPN\WllIis, (PN stealing from patient4oc -

/

47. On or about August 23, 2012, Respondent did not give

Resident IL. the $81.95 Respondent withdrew from Resident J.L.'s Bank of

America savings 1 48. On or about August 23, 2012, Respondent did not give

Resident J.L. a receipt for the $81195 Respondent withdrew from Resident

].L.'S Bank of America savings account.

49. On or about August 24, 2012, Respondent used Resident J.L.'s

Bank of America ATM card and withdrew approximately $2100 at. Expreb

Grocery from Resident J.L.'s America savings acccurit..

50. On or about August 24, 2012, Respondent did hot give

Resident IL. the $22.00 Respondent withdrew from Resident J.L/s Bank of



Resident IL. a receipt for the $22.00 Respondent withdrew from

3.L.'s .Bankbf America savings accoUnt.

52. dn or about August 27, 2012, Respondent used Resident 's Bank of America ATM card and withdrew approximately $80.00 at a Bank

of America ATM from Resident 1L.'s Bank of America sayings account.

DON V. iffany Wifils, L.P.N. 9 Case Number: 2012-15645 J:\PSU\Nurslng\Mary MIIIa\AC\unprof ccnduct\LPN\WiIfls, LPN stealing ironi


Resident IL. the $80.00 withdrew from Resident J.L.'s Bank of



Resident IL. a receipt for the $80.00 Respondent withdrew from Resident

J.L.'s Bank of America savings account.

55. From on or about June 5, 2012 until on or about August27,

2012, Resident 1L. did not personally use his Bank of America ATM card.

56 From on or about June 5, 2012 until on or about August

2Q12, Resident 3W. did not authorize Respondent to use his Bank of

America ATM card to withdraw money from his Bank of America savirjgs

- account. :.

57. From on or about June 5, 2012 until on or about: August 27,

2012, used Resident J.L.'s- Bank of America ATM card

approximately 15 timS for her personal use.


2012;. Respondent withdrew approximately $2,979.20 from Resident 1L.'s


1 v. Tiffany Willis, LP.N. - to Case Number: 2012- 15645 - - -

condud\LPr-flwillis, LPN stealing from patlent.doc

On or about December 11, 2012, in the Circuit Court fOr the

Twelfth Judicial Circuit, in and for Sarasota County, Florida, in case nurAber

2012-CF-016635-NC, Respondent was charged with pne count of Grand

Theft, a third degree felony, in violation of Section 812.014(2)(c)1, Florida

Statutes, and one count of Fraudulent Use of a Credit Card, a third degree

felony, in violation of Section 817.61, Florida Statutes. The cdminal case is

ongoing.

§9. Section 464M18(i)(h), Florida Statutes (2011)(2012), provides

that unprofessional conduct, as-defined by board rule, constitutes groupds

for discipline.

61. Rule 64B9-8.005(4), Florida Administrative Code, provides that

unprofessional conduct includes stealing from a patient.

62. As set forth above, Respondent engaged in unprofessional

conduct by stealing approximately $2,979.20.frdm Resident J.L.'s Bank of


• 63. Based on the foregoing, Respondent violated Section

• 464M18(1)(h), Florida Statutes (2011)(2012), by engaging in

unprofessional conduct, as defined by Rule 64B9-8.O05(4), Florida

Administrative Code, by stealing- from a patient.

DOll v. Tiffany Willis, LP.N. - - - 11

Case Number; 2012-15645 J:\PSU\Nurslng\Mary MiIier\AC\unprof conduct\LPN\WlllIs, LPN stealing from patlent.doc

WHEREFORE, the Petitioner respectfully reqUests that the Board of

NUrsing enter an order imposing one or more of the following pnalties:

permanent revocation or suspension• of Respondent's license,. restriction of

practice, imposition of an administrative fine, issuance of a reprimand,


fees billed or collected, remedial education and/or any other relief that the


SIGNEDth1s idayof 2013..

John I. Armstrong, MD, FACS -

Surgeon General and Secretary of Health

Mary S. " General Counsel

DOH Prosecution Services Unit

LED 4052 Bald Cypress Way, Bin C-65. OF HEALTH Tallahassee, Florida 32399-3265

1 ERK- Florida Bar Number 0780429

,., Telephone (850) 245 - 4640 4'

Facsimile (850) 245 —4683

PCP: Fthr 13 14647bcL

DOH v. tftany WUhls, L,P.N. 12 Case Number; 2012-15645

MiIIer\AC\unprof cqnduct\L?F4\Wllfls, LPN stealing from patientdoc

r.

NOTICE OF RIGHTS

Respondent has the right to request a hearing to be conducted in accordance with Section 120.569 and 120.57, Florida Statutes, to be represented by counsel or other qualifled representative, to present evidence and argument, to call and cross-examine withesses and to have subpoena and subpoena duces tecum issued on his or her behalf if a hearing is requested.


Respondent is placed on notice that Petitioner has incurred costs related to the investigation and prosecution of this matter. Pursuant to Section 456.072(4), Florida Statutes, the Board shall

to the investigation and prosecution of a disciplinary matter, which mat include attórflêy hours-and costsj on the Respondent in addition to any otherdiscipline imposed.

DOH v, liftany WilCis, LP.N. 13 Case Number: 2012-15645 ):\PSU\Nursinq\Mary MiUertAC\unprtf conduct\LPN\WiItis, LPN stealing from patlent.doc


INVESTIGATIVE REPORT

Office: Ft. Myers Date of Case: 10/19/12 Case Number: PN 2012-1 5645

Subject: TIFFANY CRESSITA WILLIS, LPN 3206 Clark Dr. Sarasota, FL 34234

(941) 355-6574 (H)

Source: PHILIP H. HIBNICK 1722 1H Street Crossbreeze Care Center Sarasota, FL 34233 (941)955-4915(W)

Prefix: License #: Profession: Board: Report Date: PN 5177791 Licensed Practical Nursing 01/08/13

Nurse

Period of Investigation: 10/23/12 through 01/08/13

Type of Report:

FINAL Alleged Violation: F.S. 456.072(1)(dd): The following acts shall constitute grounds for which the disciplinary action specified in subsection (2) may be taken: Violating any provision of this chapter, the applicable practice act, or any rules adopted pursuant thereto. 464.018(1)(h)(o) The following acts constitute grounds for denial of a license or disciplinary action, as specified in s. 456.072(2). Unprofessional Conduct... Violating any provisions of this chapter or chapter 456, or any rules adopted pursuant thereto. ,A.C. 64B9-8.005(4): Stealing from a . Synopsis: This investigation is predicated upon the receipt of a Healthcare Practitioner Complaint form, and Case Summary, Exhibit 1, submitted by PHILIP H. HIBNICK, Administrator for Crossbreeze Care Center, alleging, TIFFANY CRESSITA WILLIS, LPN misappropriated approximately $1,500.00 from patient JL, 64 y.o.a/Male.

WILLIS was notified of the investigation by letter sent on October 23, 2012, Exhibit 2, and was provided a copy of the case summary and attachments, Exhibit 1.

A check of the DOH computer licensure system reveals WILLIS is currently a Licensed Practical Nurse, with clear and active status.

Patient Notification made in person on January 7, 2013.

WILLIS is not known to be represented by an attorney.

WILLIS denies the allegation.

. Related Case: None .

Inve gatorlDate: / . Approved By/Date:

Frank A. Ashline, Fl-70 Judy Manager •!

Distribution: HQ/ISU .

:

:

Page 1

Received

'JAN 11) Z013

OOH/MQA Tallahassee HO

DOH INVESTIGATIVE REP IT CASE K )IBER: PN 2012- 15645

I. INVESTIGATIVE REPORT COVER .1

II. TABLE OF CONTENTS 2

Ill. INVESTIGATIVE DETAILS

Summary of Exhibits/Records/Documents 3 - 6

Interview of PHILIP H. HIBNICK, Administrator - Source 4 Interview of EARL RUTLAND, Investigator/AG — Witness 4 Interview of JL — Patient 5

Interview of JAVIER ORTIZ, RN — Witness 5

Written Response of TIFFANY CRESSITA WILLIS, LPN — Respondent 6

IV. EXHIBITS

• 1. Case Summary and attachments 7- 10

2. Copy of Notification letter dated October 23, 2012 11 - 13 * 3. Copy of Complainant Notification Letter (Status 30) 14 * 4. Copy of Office of the Attorney General Investigative report (MFC-1 2-01054) 15 - 46

5. Copy of Department of Children and Family Report (2012-225063-01) 47 - 49 * 6. Copy of Office of the Attorney General Investigative Report (MFC-12-01 054) 50 - 89

One (1) C/D containing twenty eight (26) photographs, Bank Statements, Audio interviews of JL and WILLIS, State Attorney Records, Hand written statements of Willis, Grievance form and PC affidavit 90 - 156

7. Copy of Crossbreeze Care Center Employee Handbook 157 - 223 * 8. Written Response of TIFFANY CRESSETA WILLIS, LPN 223 - 224 * 9. Confidential Index of Names 226

*EXHIBITS CONTAIN INFORMATION WHICH IDENTIFIES PATIENT(S) BY NAME AND ARE SEALED PURSUANT TO SECTION 456.057(10)(a), FLORIDA STATUTES

"These records are sealed pursuant to Section 456.057(10)(a), Florida Statutes and copies of same are not maintained in the Fort Myers Investigative Services office

This exhibit contains confidential records concerning reports of abuse, neglect or exploitation of the vulnerable adult, including reports made to the central abuse hotline, and is sealed pursuant to section 41 5.1 07(1), Florida Statutes.

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DOH INVESTIGATIVE REF ZT CASE F'.. .ABER: PN 2012- 15645

INVESTIGATIVE DETAILS SUMMARY OF EXHIBITSIRECORDS/DOCUMENTS

Exhibit 3 is the Complainant Notification Letter (Status 30)

Exhibit 4 is a copy of the Attorney General Investigative report (MFC-12-01054).

This record contains OAG Investigator EARL RUTLAND's investigative report concerning the alleged misappropriation of the personal funds of JL; a patient of Crossbreeze Care Center, by TIFFANY WILLIS, LPN; an employee of Crossbreeze Care Center. The record provides an overview of statements provided by involved parties and a summarization of bank records. The record informs Approximately 16 withdrawals were made by utilizing JL's personal ATM card. On three (3) occasions surveillance cameras captured a person later identified as WILLIS making cash withdrawals by utilizing JL's ATM card.

This record also includes two hand written statements made by WILLIS explaining her involvement with JL and the expenditures of JLs personal funds.

Exhibit 5 is a copy of Department of Children and Family Report (201 2-225063-01).

This record informs on October 4, 2012, it was reported to DCF that a staff member at Crbssbreeze Care Center had been utilizing a patient's ATM card without authorization.

The record states, "There is evidence that the AP took advantage of JL and did use his ATM card for a number of transactions. Some of them may have been authorized but the bulk of them were not."

The record informs DCF report was closed with a verified finding of exploitation.

The record informs DCF deferred the prosecution of the case to the Office of the Attorney General.

Exhibit 6 is a copy of Office of the Attorney General Investigative Report (MFC-12-01054) and One (1) C/D containing twenty eight (28) photographs, Bank Statements, Audio interviews of JL and WILLIS, State Attorney Records, Hand written statements of WILLIS, Grievance form and PC affidavit.

This record informs that a Capias Warrant was issued by The Circuit Court in and for Sarasota County for TIFFANY WILLIS for Grand Theft and Fraudulent Use of a Credit Card.

The Warrant is supported by a Probable Cause Affidavit which was presented by Investigator EARL RUTLAND, OAG. The affidavit is supported by Statements, Photographs and Bank Records which indicate that WILLIS accessed and took the private funds of JL without his permission. The funds were removed from JL's account by use of an ATM card which WILLIS was known to haye possessed.

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DOH INVESTIGATIVE REP IT CASE N IBER: PN 2012- 15645

Exhibit 7 is a copy of the Crossbreeze Care Center Employee Handbook, including the policy and procedure of the facility which includes the relationships between patient and caregiver.

ExhibitS is the Written Response of TIFFANY CRESSITA WILLIS, LPN.

Exhibit 9 is the Confidential Index of Names.

INTERVIEW OF PHILIP HIBNICK, ADMINISTRATOR — : Employment: 1722 TH Street Crossbreeze Care Center Sarasota, FL 34233 (941) 955-4915 (W)

On October 23, 2012, Investigator FRANK ASHLINE interviewed PHILIP HIBNICK, the Administrator at Crossbreeze Care Center, located at 1722 l&h Street, Sarasota, FL 34233. HIBNICK advised he has been the administrator of the facility since August 2012.

HIBNICK confirmed the submission of the Healthcare Practitioner Complaint form. HIBNICK informed that JL reported that TIFFANY CRESSITA WILLIS, LPN had taken money from him without authorization. HIBNICK advised it was reported that WILLIS had access to JL's ATM card and JL reported that over $1,000.00 was missing from his ATM account. HIBNICK informed he had WILLIS complete statements in which she denied taking any money from .JL for personal gain. HIBNICK advised JL admitted using cash from his ATM card to make assorted purchases for JL. I-IIBNICK advised due to the nature of JL's allegations, DCF and Law Enforcement were contacted and they responded to investigate. HIBNICK advised JL was suspended pending the outcome of the investigation.

INTERVIEW OF EARL RUTLAND, OAG INVESTIGATOR — : Employment: 3507 E. Frontage Road, Suite 325 Tampa, FL 33607 (813)287-7118 (W)

On October 23, 2012, Investigator FRANK ASHLINE interviewed EARL RUTLAND, Investigator with the Medicaid Fraud Control Unit, Office of The Attorney General. RUTLAND faxed a copy of his investigative report (Exhibit 4) to ASHLINE and confirmed the information contained therein. RUTLAND advised his investigation was being submitted for approval of an Arrest Warrant for WILLIS and he would provide additional information to ASHLINE pending the arrest of WILLIS.

On December 18, 2012, Investigator FRANK ASHLINE contacted RUTLAND. RUTLAND informed WILLIS had been arrested on December 12, 2012, pursuant to a warrant for Grand Theft and Fraudulent Use of a Credit Card. RUTLAND informed he would send his investigative reports along with a C/D containing additional investigative material (See Exhibit 6).

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DOH INVESTIGATIVE REF IT CASE JIBER: PN 2012- 15645

INTERVIEW OF JL — : On January 7, 2013, Investigator FRANK ASHLINE interviewed JL at his residence. According to JL he has a history of diabetes, heart attacks and has had three strokes. JL is wheelchair bound and has slightly slurred speech. JL appeared to me alert and oriented. JL advised be had provided sworn testimony to Investigator RUTLAND and the testimony he provided was a true accounting of his interaction with TIFFANY WILLIS (See Exhibit 6).

JL informed ASHLINE that he met WILLIS when he arrived at the facility. JL advised he became friendly with WILLIS. JL informed that WILLIS agreed to help him by taking him in her personal car to perform errands such as making small purchases, banking and taking him out to eat. JL advised he would give small amounts of money to WILLIS in appreciation for her assistance. JL confirmed that he would on occasion give money to JL to purchase food items for him. JL advised he gotten a new ATM card in the mail but WILLIS would not give it to him and she told JL she would hold it for safe keeping. JL advised he didn't think there was an issue until they day his brothers came to visit and he wanted to buy them lunch. JL advised he asked WILLIS for his ATM card and she told him that the account only had eight dollars in it. JL informed he was under the impression that the ATM account had a least fifteen hundred ($1,500.00) dollars in it. JL advised he never had authorized WILLIS to utilize the ATM card and any purchases made on the card were done without his permission. JL advised the day after the incident WILLIS approached him and told him she was sorry and she would repay the money.

INTERVIEW OF JAVIER ORTA, RN, DON. (LICENSE # 9333469) — : Employment: 1722 TH Street Crossbreeze Care Center Sarasota, FL 34233 (941) 955-4915 (W)

On January 7, 2012, InvestIgator FRANK ASHLINE interviewed JAVIER ORTA, RN at the Crossbreeze Care Center. ORTA advised he has been an RN for approximately two years and has been employed with Crossbreeze Care Center, as the Director of Nursing since July 2012.

ORTA advised when he started with the facility he noticed that TIFFANY WILLIS and JL were very friendly with each other. ORTA advised that WILLIS did not appear to have the same type of relationship with other patients that she had with JL. ORTA advised that routinely WILLIS would make arrangements for JL to eat lunch from providers outside of the facility. ORTA advised that WILLIS would either go get JL's lunch or would have it delivered. ORTA advised that although JL is wheel chair bound and has suffered strokes he is alert and oriented. ORTA advised he was made aware that JL had an issue with WILLIS using his credit card on the day JL's brothers came to visit. ORTA advise he reported the information to the administrative staff. ORTA did not have any additional information.

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DOH INVESTIGATIVE REF IT CASE K A1BER: PN 2012- 15645

WRITTEN RESPONSE OF TIFFANY CRESSITA WILLIS, LPN, (LICENSE #5177791) — : Residence: 3206 Clark Drive Sarasota, FL 34234 (941) 955-4915 (W)

On December 31, 2012, Investigator FRANK ASHLINE received a written response from TIFFANY CRESSITA WILLIS, LPN.

WILLIS writes, "... I was employed at Crossbreeze Care Center as a MDS Coordinator/Nurse Supervisor... During a regular medicare/trust meeting, the topic came up regarding JL's trust account being too high. There were other resident names as well. The administrator, LORI FORDHAM, at the time stated... I should take these residents shopping to spend down their accounts. A couple of weeks later, JL and I went shopping for several items at Walmart using money in his Bank America account because the money in his trust account at Crossbreeze had disappeared. JL became very comfortable with me... JL would come to me on a regular basis to go shopping for him or get money for him. JL would also send other staff members out for him as well... On another occasion, .JL and I went to the mall to find him some shoes, clothes, and a phone. The facility set up the trènsport... I continued to do things for JL. There were never any accusations of me stealing or taking money from him at all during this time period. The accusations came about when JL's brothers came in town... JL has always had access to account statements and activities. I had only purchased things requested by JL... I am not guilty..." (Exhibit 8).

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